To cut healthcare costs, more employers are offering second opinion services

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“Maybe you should get a second opinion.” That’s what people often hear after receiving a medical diagnosis for a potentially life-threatening condition. But how many people actually take that advice? A 2010 Gallup Poll found that 70% of Americans had faith in their physician’s diagnosis and didn’t see the need for a second opinion. That percentage is up from 64% in a 2002 Gallup Poll.

Patients’ confidence in their doctors is always a good thing, but the Gallup results raises concern. More than a third of medical diagnoses are misdiagnoses, according to Michael Hough, executive vice president at Advance Medical, a firm specializing in expert medical opinions.

If the high number of misdiagnoses isn’t reason enough for a second opinion, maybe the number of second opinions that change the original diagnoses is. A recent Mayo Clinic study found that 88% of the patients who came to the clinic for a second opinion learned that their diagnosis had been changed or moderately altered. Only 12% of the patients in the study left the clinic with the same diagnosis.

Ellen Kelsey, chief strategy officer for the National Business Group on Health (NBGH)says employers’ top three healthcare concerns are waste in the system, the wrong treatment and inappropriate care, which results in higher costs. Misdiagnoses must be avoided, she says, so employees can get well as quickly as possible.

“Cost savings is certainly a goal, but so is employee engagement,” says Kelsey. She believes employees are empowered and their medical outcomes are more positive when they're involved in their healthcare.

Hough agrees: “When you control quality, you control costs.” Second opinion services might add cost to the front end of treatment, he says, but the goal is quality care, which saves healthcare costs in the long run.

When is a second opinion necessary?

People normally associate second opinions with catastrophic medical conditions. The Mayo Clinic recommends that patients get a second opinion when they're:

not comfortable with their local medical team, its expertise or the treatment options it offers;

diagnosed with an unusual or rare cancer;

running out of treatment options;

interested in taking part in clinical trials; or

taking their local doctor's advice to see another provider.

When the diagnosis is a rare, dire or life-threatening condition, patients need another set of eyes on the situation, says Arthur Leibowitz, M.D., chief medical officer, founder and president of Health Advocate. However, he says that second opinions aren’t just for the most serious diagnoses.

“Out of 80,000 second opinions we studied, only 346 were for extreme medical conditions,” says Leibowitz, adding that getting a second opinion depends on the patient’s comfort level. In short, patients can seek a second opinion for any kind of health problem.

For catastrophic health conditions, second opinions can catch a problem in its earliest stages before more invasive, costlier treatment becomes necessary. In general, another expert opinion can bring patients peace of mind and some assurance that they received the best and latest course of treatment available for their condition, says Hough.

Who are the second-opinion providers?

The providers are specialists, many of whom are nationally or world renowned for their expertise, says Kelsey.

Some experts are so specialized that they’re recommend to patients for narrowly focused medical conditions. Leibowitz described the work of a provider who specializes in treating ballet dancers and others who treat either right or left leg problems, but not both.

The average person can’t navigate the system alone.

Ellen Kelsey

Chief Strategy Officer, NBGH

“You want to be where the cutting-edge work is being done,” says Leibowitz, referring to the constant breakthroughs in medical treatment. “[Specialization] is a new way of fixing an old problem. Second opinions are about getting the best possible diagnosis and the latest treatment for it."

Are people often reluctant to get a second opinion because they don’t want to offend their trusted physician? Yes, says Hough, but he adds that physicians learn from each other and consult one another all the time, so they’re receptive to other opinions.

What second opinion services mean for employers

Second opinion services are becoming mainstream, says Kelsey. NBGH statistics show that 66% of employers now offer them, an increase of 47% over last year. Services can either be part of a health plan or a stand-alone benefit; employers pay a fee for second opinion services, which are offered to all employees and usually cover others on the plan, says Kelsey.

Second opinion services might differ by agency and structure, but, generally, the physicians involved with the patient’s care do a clinical review and refer the patient to a specialist, often via a telephone consultation with the patient. The specialist then requests the patient’s medical history, including blood work, laboratory results, primary care physician records and all other health-related documentation. The consultation and information become the basis for a second diagnosis.

“Healthcare is complicated,” said Kelsey. “The average person can’t navigate the system alone,” she said, adding that employees can have peace of mind knowing they have support from their employer and the benefit of second opinion services. Employers benefit, she says, when a diagnosis is accurate and workers get the quality treatment they need and are back on the job.